On-call hospital pharmacy services in NHS England: service provision and documentation of medicines advice calls

Objectives UK hospital pharmacy services have historically been delivered during typical ‘office’ hours, which include the provision of medicines advice via the pharmacy's medicines information department. Outside office hours, an on-call service operates whereby pharmacists handle requests for medicine supply and advice. It is not known how this out-of-hours service operates. The aim of this study was to quantify the extent and scope of its provision across England. Methods A piloted self-administered survey was sent to every chief pharmacist in England representing acute hospitals and mental health trusts (n=218). Key findings Just over half (n=116/218, 53.2%) of chief pharmacists returned a completed survey. Most hospitals provided an on-call pharmacy service (87.1%, n=101/116). Nearly all on-call pharmacy services (91.1%, n=92/101) provided both supply of medication and medicines advice. Two-thirds (66.2%) of pharmacists who provided on-call services were junior. The majority of trusts (83.1%, n=74/89) receive <20 calls for medicines advice per week. Hospital nurses/midwives were seen as the most common users of the on-call pharmacy service. Medicines advice was documented by on-call pharmacists all (49.5%, n=47/95) or some of the time (49.5%, n=47/95). Just under half of trusts (41.1%, n=39/95) had a standard policy for the documentation of medicines advice. Two-thirds (66.7%, n=62/93) of respondents stated that advice was documented using paper-based forms. Most trusts (81.1%, n=77/95) provided training prior to pharmacists being on-call, with medicines information pharmacists involved in nearly 80% of cases (n=61/77) (respondents could select more than one option). Conclusions Medicines advice is an integral part of the pharmacy on-call service, which was provided by junior staff. Variability existed in resourcing the service across trusts. In addition to existing standards for documentation of medicines advice, professional standards should be developed for on-call hospital pharmacy service provision and training

Medicines advice out of hours: exploring the opinions of healthcare professionals on the use and provision of on-call pharmacy services in England

Provision of NHS hospital pharmacy services has historically been delivered during typical ‘office’ hours. During these hours most pharmacy departments provide a medicines information (MI) service where any healthcare professional can ask for medicines advice. Outside of these hours questions are handled by an on-call pharmacist. This study aimed to investigate the provision of pharmacy services and medicines advice out of hours, from the perspective of pharmacists and other healthcare professionals, in NHS England. A mixed methods approach was used: an online survey of all Chief Pharmacists in England (2012: n=220) and semi-structured interviews of on-call pharmacists (2014: n=8) and doctors and nurses (2015: n=3 & n=4 respectively) in the East of England. The online survey provided information about the provision of on-call pharmacy services in England, documentation of calls handled, and provision of relevant training. Semi-structured interviews generated 19 themes, grouped into 5 meta themes: documentation, individual’s knowledge and experience, information accessibility, use of service, and awareness of service. On-call pharmacy services were provided by most hospitals, predominantly by less senior staff with limited years’ experience. Documentation of questions was variable, and less than half of Trusts had a documentation policy. Documentation by on-call pharmacists was found to be affected by their knowledge and experience, if they had any concerns about the enquirer’s understanding, the time the call was received, and remuneration and Information Technology (IT) issues. Both Chief Pharmacists and on-call pharmacists identified that training mainly consisted of operational issues, with on-call pharmacists believing a greater role could be played by MI staff in this training. Drug administration and ‘medication safety check’ were the main types of medicines advice questions sought out of hours. Chief Pharmacists stated on-call pharmacy services were well advertised but doctors and nurses seemed unaware of its provision and means of access; on-call pharmacists perceived this to be due to a lack of promotion. Access to information out of hours, particularly patients’ drug and clinical information, by on-call pharmacists was a barrier to providing medicines advice. This is the first insight into the national landscape of on-call pharmacy services. There is a clear role for MI services to support on-call pharmacy services, and national standards should be developed for provision, information accessibility, documentation and training. National pharmacy policy makers could also consider structured training, repeated on a regular basis, for all on-call pharmacists

SLC2A9 Is a High-Capacity Urate Transporter in Humans

Serum uric acid levels in humans are influenced by diet, cellular breakdown, and renal elimination, and correlate with blood pressure, metabolic syndrome, diabetes, gout, and cardiovascular disease. Recent genome-wide association scans have found common genetic variants of SLC2A9 to be associated with increased serum urate level and gout. The SLC2A9 gene encodes a facilitative glucose transporter, and it has two splice variants that are highly expressed in the proximal nephron, a key site for urate handling in the kidney. We investigated whether SLC2A9 is a functional urate transporter that contributes to the longstanding association between urate and blood pressure in man

Regulation of jejunal glucose transporter expression by forskolin

We have investigated the effects of forskolin on enterocyte membrane expression of the glucose transporters, SGLT1 and GLUT2, which are thought to be the main entry and efflux pathways for glucose, respectively. Forskolin treatment increased SGLT1 but decreased GLUT2 expression in mid and lower villus enterocytes. No change in transporter expression was noted in upper villus cells. Likewise, cyclic AMP levels were raised in mid and lower but not upper villus cells. The implications of these data for glucose transport are discussed

Demonstrating In-Cell Target Engagement Using a Pirin Protein Degradation Probe (CCT367766)

Demonstrating intracellular protein target engagement is an essential step in the development and progression of new chemical probes and potential small molecule therapeutics. However, this can be particularly challenging for poorly studied and noncatalytic proteins, as robust proximal biomarkers are rarely known. To confirm that our recently discovered chemical probe <b>1</b> (CCT251236) binds the putative transcription factor regulator pirin in living cells, we developed a heterobifunctional protein degradation probe. Focusing on linker design and physicochemical properties, we generated a highly active probe <b>16</b> (CCT367766) in only three iterations, validating our efficient strategy for degradation probe design against nonvalidated protein targets

Stochastic modelling of chromosomal segregation:errors can introduce correction

Cell division is a complex process requiring the cell to have many internal checks so that division may proceed and be completed correctly. Failure to divide correctly can have serious consequences, including progression to cancer. During mitosis, chromosomal segregation is one such process that is crucial for successful progression. Accurate segregation of chromosomes during mitosis requires regulation of the interactions between chromosomes and spindle microtubules. If left uncorrected, chromosome attachment errors can cause chromosome segregation defects which have serious effects on cell fates. In early prometaphase, where kinetochores are exposed to multiple microtubules originating from the two poles, there are frequent errors in kinetochore-microtubule attachment. Erroneous attachments are classified into two categories, syntelic and merotelic. In this paper, we consider a stochastic model for a possible function of syntelic and merotelic kinetochores, and we provide theoretical evidence that merotely can contribute to lessening the stochastic noise in the time for completion of the mitotic process in eukaryotic cells.PostprintPeer reviewe

Women's Wages: Cohort Differences in Returns to Education and Training Over Time

This article examines the effects of education and work-related training on wage-growth trajectories for two cohorts of women as they aged from their early 20s and 30s into their early 30 s and 40 s. I test whether occupational training compensates for an earlier lack of education, thereby decreasing earnings inequality over time within cohorts. Because the broader economic context may influence the relationship between wages, education, and training, I test the assumption that the experiences of a given cohort may be generalized to others. Copyright (c) 2005 by the Southwestern Social Science Association.